Access to Reproductive Health Services Among People With Disabilities.

Importance: People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability types and statuses is unknown. Objective: To assess the national prevalence of barriers to RH access experienced by people with disabilities. Design, Setting, and Participants: This cross-sectional study analyzed results of an online probability-based national survey of RH experiences that was conducted from December 2021 to January 2022. The national sample consisted of English- and Spanish-speaking panel members of a market research firm. Panelists were invited to participate in a survey on their RH experiences and opinions. These participants were aged 15 to 49 years and assigned female at birth (AFAB). Weighted proportions were estimated, and bivariable and multivariable regression analyses were performed to assess associations between disability status and barriers to accessing RH services. Exposure: Using 5 of the 6 Washington Group Short Set on Functioning items, 8 dichotomous disability indicators were created: (1) vision, (2) hearing, (3) mobility, (4) activities of daily living, (5) communication, (6) overall disability status (a lot or more difficulty functioning in ≥1 domain), (7) some difficulty functioning (below the disability threshold; some or more difficulty functioning in ≥1 domain), and (8) multiple disabilities (a lot or more difficulty functioning in ≥2 domains). Main Outcomes and Measures: Number and types of barriers (logistical, access, cost, privacy, and interpersonal relationship) to accessing RH services in the past 3 years. Results: After exclusion, the final sample included 6956 people AFAB, with a mean (SD) age of 36.0 (8.3) years. Of these participants, 8.5% (95% CI, 7.6%-9.5%) met the disability threshold. Participants with disabilities compared with those without disabilities were disproportionately more likely to be non-Hispanic Black (18.8% [95% CI, 14.4%-24.1%] vs 13.2% [95% CI, 11.9%-14.5%]) or Hispanic or Latinx (completed survey in English: 18.1% [95% CI, 14.0%-23.0%] vs 14.6% [95% CI, 13.3%-16.0%]; completed survey in Spanish: 8.9% [95% CI, 6.2%-12.8%] vs 6.2% [95% CI, 5.4%-7.1%]) individuals, to identify as LGBTQAI (lesbian, gay, bisexual, transgender, queer [or questioning], asexual [or allied], intersex; 16.4% [95% CI, 12.3%-21.6%] vs 11.8% [95% CI, 10.6%-13.1%]), to live below the federal poverty level (27.3% [95% CI, 22.3%-32.8%] vs 10.7% [95% CI, 9.7%-11.9%]), and to ever experienced medical mistreatment (49.6% [95% CI, 43.7%-55.5%] vs 36.5% [95% CI, 34.8%-38.2%]). Among those who had ever tried to access RH services (n = 6027), people with disabilities vs without disabilities were more likely to experience barriers (69.0% [95% CI, 62.9%-74.5%] vs 43.0% [95% CI, 41.2%-44.9%]), which were most often logistical (50.7%; 95% CI, 44.2%-57.2%) and access (49.9%; 95% CI, 43.4%-56.4%) barriers. The disability domains with the highest proportion of people who experienced 3 or more barriers in the past 3 years included activities of daily living (75.3%; 95% CI, 61.1%-85.6%), communication (65.1%; 95% CI, 49.5%-78.1%), and multiple (59.9%; 95% CI, 45.6%-72.7%) disabilities. Conclusions and Relevance: This cross-sectional study found large disparities in access to RH services among people AFAB with disabilities. Findings indicated a need to alleviate barriers to RH care, including improving the transportation infrastructure and reinforcing patient-centered approaches that engender inclusivity in health care settings.

Maternal healthcare use by women with disabilities in Rajasthan, India: a secondary analysis of the Annual Health Survey.

BACKGROUND: Women with disabilities face a number of barriers when accessing reproductive health services, including maternal healthcare. These include physical inaccessibility, high costs, transportation that is not accessible, negative attitudes from family and healthcare providers, and a societal belief people with disabilities shouldn't be parents. While qualitative studies have uncovered these barriers, there is limited quantitative research to determine their effect on use of maternal health services. This study aims to analyze associations between disability and maternal healthcare use among married women in Rajasthan. METHODS: This study is a secondary analysis of the Indian Annual Heath Survey first wave data from 2011. The sample includes 141,983 women aged 15-49 who had given birth between 2007 and 2009. Logistic regression was used to assess the association between disability and use of antenatal, delivery, and postnatal care. Stratified models were created to analyze difference based on birth order of the pregnancy and whether the woman's place of residence is rural or urban. RESULTS: The prevalence of disability was 1.23%. Attending at least three antenatal care visits was reported by 50.66% of the sample, skilled delivery use by 83.81%, and receiving postnatal care within 48 h of birth by 76.02%. In the regression model, women with disabilities were less likely to report attending the minimum antenatal care visits (OR = 0.84; CI: 0.76, 0.92). No association was found between disability and skilled delivery or postnatal care. Once the sample was stratified by birth order, women with disabilities reporting their first birth were more likely to report receiving postnatal care than women without disabilities (OR = 1.47; CI: 1.13, 1.91). CONCLUSION: Additional research is needed to determine use of maternal healthcare among women with disabilities in India. Maternal services need to be assessed to determine their accessibility, especially regarding recent laws requiring accessibility.

Use of modern contraceptives by women with disabilities in Rajasthan, India: An analysis of the annual health survey.

OBJECTIVE: The objective of this study is to analyze associations between disability and contraceptive use among married women in Rajasthan, India. METHODS: The study uses secondary analysis of the Rajasthan dataset of the 2010-2011 Annual Heath Survey. This survey included both disability and reproductive health data. The sample includes 238,240 women aged 15-49 years. Logistic regression is used to measure associations between disability status and use of modern contraceptives and female sterilization in the sample. Stratified analyses by age and residence were also conducted. RESULTS: The prevalence of disability among women of reproductive age was 0.9%. Modern contraceptive use was reported by 73.0% of the sample, and female sterilization by 57.7% of the sample. Women with disabilities (WWD) were less likely to report using a modern contraceptive (OR 0.87, 95% CI: 0.78, 0.95). Among modern method users, WWD were not significantly more likely to be using sterilization than another modern method; however, there were significantly higher odds of sterilization versus another modern method for urban WWD (OR 1.57, 95% CI: 1.11, 2.22). CONCLUSIONS: In this study, disability was associated with contraceptive use. Additional research is needed to determine if there is a causal relationship between disability and contraceptive use. Family planning providers should be trained to provide care to WWD and the Government of India should ensure the National Family Planning Programme is accessible to people with disabilities.

Availability and quality of global disability data: A commentary on the Demographic and Health Surveys.

In the field of global health, there are very little data available regarding disability. Global health datasets including disability indicators operationalize the term disability in a variety of ways, making calculating global trends and cross-country comparisons by researchers difficult. The Washington Group on Disability Statistics has developed easily implemented questionnaires regarding disability to increase the availability of disability data. In 2014, the Demographic and Health Surveys program developed a disability data collection module based on the Washington Group Short Set of Questions. It is an optional module and has been implemented in fewer than 20 countries. Some countries had made adjustments to the questions while other countries have included disability using completely different questionnaires. This doesn't solve the problem of data consistency and cross-country comparison. Based on the data collected, there are also concerns regarding the quality of the available data and how the data is being collected.

Barriers to reproductive health services for women with disability in low- and middle-income countries: A review of the literature.

The aim of this literature review is to determine the existing literature regarding access to reproductive health services for women with disabilities in low- and middle-income countries. PubMed, Web of Science, and EBSCOHost Global Health were searched for articles focused on this topic. A total of 16 articles were included in the review. Of these, nine were qualitative, two were mixed-methods, two were literature reviews, one was a policy review, one was a descriptive cross-sectional study, and one was a case-control study. The studies took place in eleven countries in Africa and Asia. Data was extracted from the articles and analyzed using Levesque's Model of Healthcare Access to determine themes apparent in the articles. Key barriers to access included: negative attitudes of providers and society; lack of trained providers; assumptions and inadequate knowledge amongst providers; communication limitations; inaccessible facilities; lack of transportation; high costs of care; unnecessary referrals; and risk factors like being low-income or experiencing violence. Based on this analysis, policies mandating inclusion of people with disabilities are necessary. Also, providers must receive additional education and training regarding disability. Facilities and transportation should be accessible for people with mobility and sensory limitations. Future research needs to be conducted to determine reproductive health service use and outcomes amongst women with disabilities. Datasets for reproductive health should disaggregated based on disability status to facilitate this research.